Self-Funding

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Understanding Self-Funded Healthcare: A Strategic Advantage

What is Self-Funding?

Self-funding is a strategic approach where employers take direct responsibility for their employees' healthcare costs rather than paying premiums to an insurance carrier. Think of it as moving from renting to owning your healthcare program – you gain control, transparency, and the opportunity to benefit from good healthcare management.

Why Consider Self-Funding?

  1. Financial Control & Transparency

  • Access to your own claims data and spending patterns

  • Pay for actual healthcare costs rather than inflated premiums

  • Immediate cash flow advantages – pay claims as they occur rather than pre-funding

  • Potential tax benefits and exemption from state premium taxes

  • Average savings of 15-30% compared to traditional fully-insured plans

  1. Customization & Flexibility

  • Design plans that fit your workforce's specific needs

  • Choose your own provider networks and pharmacy benefits

  • Implement innovative programs like direct primary care or centers of excellence

  • Adjust benefits mid-year based on emerging needs

  • Control your own destiny rather than being subject to carrier decisions

  1. Risk Management

  • Stop-loss insurance protects against catastrophic claims

  • Sophisticated data analytics help predict and manage costs

  • Proactive risk management through wellness initiatives

  • Better control over reserve funds

Why 150+ Employees?

  1. Companies with 150+ employees typically have

  • Sufficient size to spread risk effectively

  • Predictable claims patterns

  • Financial stability to handle claims fluctuations

  • Enough premium volume to offset fixed costs

  • Better negotiating power with providers and vendors

  • More sophisticated HR infrastructure to support the program

NOTE: Self-funding can be done with fewer than 150 employees, we just benchmark 150 as a common number.

The Optimus Group Advantage

Our Unique Approach

We don't just help you switch to self-funding – we transform your entire healthcare strategy:

1. Deep Analysis

  1. Comprehensive claims analysis

  2. Population health assessment

  3. Financial modeling and projections

  4. Risk tolerance evaluation

2. Strategic Design

  1. Custom plan architecture

  2. Innovative cost containment strategies

  3. Integrated wellness programs

  4. Risk management solutions

3. Expert Implementation

  1. Seamless transition management

  2. Employee communication programs

  3. Vendor selection and coordination

  4. Compliance guidance

4. Ongoing Optimization

  1. Regular performance reviews

  2. Data-driven decision making

  3. Proactive cost management

  4. Continuous improvement strategies

Is Self-Funding Right for Your Organization?

Ideal Candidates Have

  • 150+ employees

  • Stable workforce

  • Strong financial position

  • Commitment to employee health

  • Desire for healthcare program control

  • Interest in data-driven decision making

Our Guarantees

Unlike traditional consultants, we put our money where our mouth is:

  • Guaranteed savings targets

  • Performance-based compensation options

  • Transparent reporting and accountability

  • Regular ROI assessments

Success by the Numbers

Our self-funded clients typically experience:

  • 20-30% reduction in healthcare spending

  • 15% decrease in pharmacy costs

  • 90% employee satisfaction rates

  • 98% client retention rate

Remember: In today's healthcare environment, it's not just about saving money – it's about building a sustainable, effective healthcare strategy that works for both your organization and your employees. Self-funding, when properly implemented, delivers on both fronts.

Ready to Learn More?

Contact Optimus Group for a complimentary analysis of your current healthcare program and potential savings through self-funding. We'll show you exactly how much you could save and how we'll help you get there.

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